America 250: The rise of oral health as a window into overall health

Oral health refers to the condition of the mouth, teeth, gums and oral-facial system. While it affects the ability to eat, speak and smile, it is also closely linked to overall health — a connection that was not always widely understood.

According to the American Dental Association, the idea that oral bacteria could cause disease has been discussed since the late 19th century. During that period, however, dental care largely consisted of extracting teeth to relieve pain, said Melissa Burroughs, senior director of public policy at the CareQuest Institute for Oral Health.

“This was around the same time the American Medical Association was beginning to form on the medical side,” Burroughs said. “Dentists wanted to be part of that, but they weren’t necessarily operating under the same standards of patient-centered care.”

That divide led to dentistry becoming a separate industry, Burroughs said, and may help explain why many people did not view dental care as part of health care overall.

“It’s really not reflective of how care is or should be,” she said. “But that history is there, where dentistry kind of separated off.”

In 2000, Surgeon General David Satcher released a report called “Oral Health in America: A Report of the Surgeon General,” which was the first of its kind to inform Americans about the connection between oral health and overall health and well-being. The report aimed to promote preventive care, highlight oral health disparities and encourage a comprehensive approach to improving oral health nationwide.

Eighteen years later, then-Surgeon General Jerome Adams tasked the National Institute of Dental and Craniofacial Research (NIDCR) with developing an updated report on the status of oral health, its links to overall health, and persistent disparities and inequities.

The institute has supported research on the connection between the mouth and the body for about 40 years. During that time, researchers have identified links between oral health conditions, including periodontal disease and tooth decay, and broader health issues such as diabetes, cardiovascular disease and cancer.

Burroughs also pointed to a lack of access to care as a reason many people may not understand the importance of oral health. About 70 million adults in the United States don’t have dental coverage, she said.

“That really puts dental care out of reach for a lot of people,” Burroughs said. “Or maybe you live in a place that doesn’t have a dentist who will accept the type of insurance you have. So there’s a care problem.”

Despite those challenges, Burroughs said there has been significant progress over the past 25 years in recognizing oral health as a critical component of overall health.

“I think we’ve started to see policymakers at all levels of government really understand the importance of oral health and want to make a change,” she said. “They’re realizing that for this country to be the best it can be, oral health needs to be part of the broader health conversation.”